Between Similarity and Difference

If I were to have tagged a subtitle onto this piece, it would have been something like “the fundamental paradox in interpersonal therapy”.  The interpersonal tradition in psychoanalysis continues to fascinate me in terms of the rich tradition and unique set of principles it delivered over to the practice of psychoanalysis.  In addition to reading some Levenson and Hoffman, I have been sifting through New Books in Psychoanalysis’ past interviews with prominent folks within this framework.  One who has been a recurring guest on the program is Irwin Hirsch, probably best known for a text called Coasting in the Countertransference, a book about what we as practitioners overlook when working with our clients in order to maintain the equilibrium of a comfortable therapeutic arrangement.  I think this text and Darlene Ehrenberg’s The Intimate Edge are inching closer to the top of my “Read Next” list, as they’ve both come up repeatedly as I’ve been parsing the essential texts in this tradition.

Hirsch frequently cites a particular maxim of Harry Stack Sullivan’s, which is that “we are all much more simply human than otherwise”.  With this quote, Sullivan was trying to get at the universal quality of what it means to be human.  That there is something essential to each of us that cannot be divorced from the challenges of what it means to have been thrust into the world and confronted with the task of trying to make sense of it.  We all navigate complex social dynamics; have needs which often struggle along some continuum of satisfaction and frustration; love, hate, and desire (sometimes—with each of these—much more liberally than we ought to); strive for what we might be, while being restrained by the incessant nagging of our past; navigate and negotiate rich inner worlds, shot through with a variety of emotions and sensations which often resist easy organization; and do all of this while having to bear upon ourselves the subtle and intractable losses endemic to the experience of being situated in—and by—time.

This is an important principle for those who work interpersonally.  One of the biggest shifts that has evolved out of that movement is the leveling of the hierarchy in the therapeutic dyad.  The sentiment for many years was that therapy was in someways about a “well” person bringing their influence and expertise to bear upon someone who was comparatively “unwell”.  Sullivan and the practitioners who came down stream of him were less convinced of this way of understanding the therapeutic relationship, noting the strangeness of assuming that the person doing the therapy was somehow more “well”.  In the classical tradition, this was part of the importance of the training analysis.  It was assumed that by going through an analysis of their own, the analysts practicing could more effectively embody the position of the “blank screen” that Freud advocated for.  In the world of the traditional Freudians, countertransference was a contaminant that needed to be eliminated from the therapeutic encounter, particularly if the transference was going to be properly analyzed.

The interpersonalists see this as an impossibility within the context of the kind of relationship that psychotherapy and psychoanalytic work require us to develop with the folks we work with.  As writers in most analytic traditions like to point out, even Freud himself seemed pretty unconvinced of the idea that the analyst could or ought to operate like a blank screen in the relationships, often having been reported as seeming a quite active participant in the analyses that he conducted with his patients.  Nonetheless, an argument could still be made that even all the considerations taken to potentially minimize the analyst’s involvement are themselves a kind of involvement.  At which point, the task of psychotherapy must inevitably move to incorporate not just the analysis of the intrapsychic processes of the person being worked with, but also the specific structure of the therapeutic field and how it is co-constructing the type of enactments that are being invited into the analysis.

This shift in emphasis highlights a different kind of evaluation that is going on in the understanding of what we are to make of the therapeutic relationship.  If we are to admit that we bring a kind of influence to bear on the arrangement, and that that influence carries within it some of our own enactments (Freud’s own neuroses are all over the concept of the blank screen), then therapy becomes less a meeting of the well and the unwell, and more so a meeting of two flawed individuals who are putting to themselves the task of using their mutual experience to the benefit of one participant in that arrangement more so than the other.

Though a curious tension emerges when you begin to reflect on this in the context of another important concept in the interpersonal tradition: the detailed inquiry.  Sullivan was especially uninterested in the idea of analyzing the transference.  In fact, Sullivan himself did not see himself as practicing analysis, but rather an interpersonal form of psychiatry.  Nonetheless, as adoptees continued to blend his influence with that of Fromm and Thompson (the other founders of the White Institute and progenitors of the interpersonal tradition), one of the central aspects of Sullivan’s technical considerations that carried over was the notion of the detailed inquiry.  Essentially, though Sullivan was disinterested in what was happening in the emerging dynamic between client and therapist, he was interested in nearly everything else.  An anecdote about a night out with a partner could elicit any of a host of questions designed to get at a concrete and nearly literal reappraisal of the night’s series of events.  Where did you go?  Where was the table located in the restaurant?  Who sat closest to the door?  Did you initiate conversation or did they?  What was the tone of the discussion?  What did everyone order and were there any issues with the preparation?  You get the idea.  For Sullivan the devil really was in the details.

Of course, this butts up against the interesting dimension of these two interpersonal maxims.  On the one hand we have this notion that humans are somehow universal and, in ways that matter, fundamentally the same.  On the other, the specificity at which our lives operate bears significant influence on the sort of maladies we bring into the psychiatric office.  If we are all fundamentally similar, then why should the detailed inquiry matter?  Surely the only reason to parse out the intricate details about a single event is to be in service of something organized around a quality of uniqueness.

The interpersonal tradition is not only about what happens when two separate subjectivities collide.  It is also about the internal relation between personhood and the personal.  What we bring to this particular project of being human matters.  Yes, we are all more or less similar in profound ways that allow for the possibility of empathizing with some of the most challenging and disorienting of circumstances our clients might bring into our work together.  And, also yes, how I attempt to maneuver my way through the complexities of my own existence is going to bear some influence and create some level of distinction between the way another chooses to do it, in ways that resist the sense that there could be anything seemingly universal about who we are and how we operate.

It can be an interesting dialectic to explore with our clients and to notice where and how they become more generalizing and when they become overwhelmed with the specificity of their own suffering.  Consideration as to how to respond in those instances demands clinical sensitivity.  Perhaps the client can tolerate the examination of a particular transference reaction that seems to be driving that approach based on their own psychodynamics.  On the other hand, it may be the case that we simply need to provide containment and validation to make up for some developmental relational need the client was deprived of in the past.  Interpersonal approaches introduce another possibility.  Here, the countertransference becomes the point of entry, using our perceptions not to comment on something happening inside of the client that we can detect in the field, but to bring to light something happening between client and therapist that is being expressed through the relationship between both participants.  That where and in what way the client’s own internal sense of the dialectic between the general and specific takes expression in the relationship has something to do with the dialectic being negotiated between self and other, necessitating a hermeneutic interpretation of what happens when all those tensions come into dialogue with one another.

In therapy, we are constantly asking our clients to hold the tension of what it means to be more human than otherwise, whilst knowing that the ways in which they understand this task of being human take a particular kind of expression in the world they have been given over to.  That condition of being given over will eventually come to include whichever therapist they decide to pursue this work with, bringing the temporal aspects of the therapeutic relationship to bear on the temporal aspects of their life more broadly.  And that specificity is of course what is most universal about honoring the density of interpretive turns that could be brought upon any given set of relationships in our lives—whether with our self, others, or the world writ large.  The leveling function of which Sullivan speaks has its basis in the fact that we might never be able to fully know the contours of an existence that is in the constant flux realized when a world full of subjectivities each bring to bear upon one another the impossibilities of their own experience.  This unyielding project of constant becoming and never being sure.

That is what the interpersonal tradition has to offer us as it has evolved over the years.  There is faith among its practitioners in the beauty of the ambiguity and constant movement that define our experience.  And a confidence that in being able to hold that tension, we can invite something remarkably poignant into the impossible to manage universal specificity of everyday going on being.